Adolescents and women who have experienced violence are more likely to contract HIV and less likely to control it

A history of intimate partner violence and/or sexual abuse was associated with lower adherence to HIV treatment among young people living with HIV in South Africa, according to a study published in . 24th International AIDS Conference (AIDS 2022).

Another study presented at the same session found that adolescent girls and women in sub-Saharan Africa who had recently experienced intimate partner violence were more than three times more likely to be infected with HIV and to live with HIV. If so, it is unlikely that you are suppressing the virus.

Globally, people living with HIV are more likely to experience intimate partner violenceand violence is recognized as a major driver of the HIV epidemic among adolescent girls and women in sub-Saharan Africa. Understanding and addressing the impact of violence on HIV prevention and treatment outcomes to do 95-95-95 goals.

Adolescents living with HIV in South Africa

Professor Lucy Kluber from the University of Cape Town presented the results of a longitudinal study that followed 1046 adolescents (ages 10-19) living with HIV. Participants were recruited from over 70 healthcare facilities in the Eastern Cape Province of South Africa. The researchers had access to their clinical records, and between 2014 and 2018 he interviewed them three times.

Thirty-seven percent of participants reported a lifetime history of intimate partner violence or sexual abuse. Of the 57% of female study participants, 23% reported lifetime exposure to intimate partner violence or sexual abuse, 5% reported both, and 11% experienced violence in the last two years. reported that it did.

About half (51%) of the participants reported consistent adherence to HIV treatment. After adjusting for other factors, intimate partner violence was associated with lower adherence (adjusted odds ratio 0.39, confidence interval: 0.21-0.72, p = 0.003). Similar to sexual abuse (aOR 0.54, CI: 0.29-0.99, p = 0.048).

Given that participants were followed over time, researchers could build a validated repeated-measures random-effects model for viral load suppression to predict the impact of violence on adherence. I got

In this model, adolescents reporting no history of violence had a 72% probability of compliance (CI: 0.70-0.74), whereas they reported both intimate partner violence and sexual abuse. Adherence rates for adolescents were found to be 38% (CI: 0.20-0.56). The study found that more girls than boys experienced violence, but the impact of violence on compliance was similar for men and women.

Longitudinal study designs included the ability to see how the experience of violence affected adherence over time and a high degree of confidence in the causal relationship between history of violence and reduced adherence. It had some strengths.

HIV-infected women in sub-Saharan Africa

Salome Kutukize of McGill University presented a large meta-analysis examining how violence affected HIV infection rates, treatment adherence, and viral suppression among women in sub-Saharan Africa.

Researchers pooled the results of nationally representative cross-sectional surveys that included information on physical or sexual violence from 2000 to 2020. It included 50 studies from 30 countries. About half of the surveys were from East Africa and a few from Southern Africa.

Researchers pooled 273,000 survey responses from previously married or partnered women between the ages of 15 and 65. Overall, 32% of her respondents reported a lifetime history of violence from a physical and/or sexually intimate partner, and 22% reported experiencing violence in the previous year.

After adjusting for other factors, respondents who experienced intimate partner violence in the previous year (n=19,179) were 3.22 times more likely to be infected with HIV (CI: 1.51-6.85). He was also 2.75 times more likely to have had recent HIV infection (CI: 1.26-6.00) within the past 4-7 months.

The study found no relationship between HIV testing and recent violent experience. The decline in treatment utilization by those who reported recent violence was not significant after adjusting for other factors.

Women living with HIV who had experienced violence in the previous year (n=5627) were 9% less likely to have suppressed the virus (CI: 0.85-0.98). This decline in viral suppression is likely due to adherence, as there was no difference in treatment uptake and the decline in viral suppression rates was still significant when the analysis was restricted to women on HIV treatment only.

Conclusion

Although the two studies differed greatly in design, they showed similar relationships between experiences of violence and HIV outcomes, particularly adherence. In a question and answer session, researchers discussed potential mechanisms linking HIV and violence.

In some cases, violence-related HIV infection can result directly from sexual assault. Violence against women living with HIV can result from HIV infection. These statements may be true, but the reality is not always so simple and there are many unknowns.

Kuchukhidze noted that looking at recent HIV infections in their study, the data suggested that the experience of violence preceded HIV acquisition and was therefore not a consequence of HIV acquisition. However, one of the audience members pointed out how HIV criminalization laws are known and emphasized that violence often follows an HIV diagnosis. increase violence against women.

Questions remain about how experience of violence, particularly ongoing violence in the context of an intimate relationship, affects adherence and/or viral suppression. The psychological effects of experiencing violence may also play a role, Kluber points out. While the audience asked whether psychological or emotional violence was captured in the meta-analysis, Kutschidze said non-physical violence was not consistently asked or recorded in the survey. I got

Another audience member hypothesized that there may indeed be a biological mechanism contributing to the reduced rate of viral suppression, and her current doctoral research suggests that violence increases the stress hormone cortisol. Kluber welcomes this research avenue and believes it will help address remaining difficult questions.

Despite these unknowns, some things are clear. Responding to an audience question about effective screening tools, Cluver said the problem is not the lack of screening tools. Some already exist, but service providers are afraid to ask questions because the real gap is the lack of services to refer people to.

Taken together, these studies highlight the urgent and unmet need for implementing effective violence prevention and post-violence services at scale.

Audience members put it best by commenting:

“It’s disappointing to see so much data being collected and not so much in terms of intimate partner justice, regardless of HIV or sexuality. We are always dying women.” We are experiencing a lack of justice, which is why we need a universal, multi-sectoral approach in combating gender-based violence. It’s not enough for them to acknowledge that it’s happening, but at the end of the day, we don’t have the structure or plan to deal with everything we face.”

Kluber agreed and replied: “Sometimes we get buried in statistics because statistics are easier than scary reality.”